Flat Feet – Everything You Should Know

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While it would seem to make sense for your feet to be perfectly flat when striking the ground, this isn’t the case with normal feet.

In order to achieve a proper balance and distribution of weight, only part of a healthy foot is on the ground at any one point while walking or running.

If the entire sole of your foot is on the ground as you stand, you have collapsed or flattened arches.


Understanding Flatfeet or Fallen Arches

Everybody has feet that are flat at birth. However, the natural arch of the foot normally develops later and there is no further issue.

For some people, however, that arch never develops, resulting in what’s described as either fallen arches or flat feet.

It’s estimated that anywhere from 20 to 30 percent of the population has flat feet.

The easiest way to determine if you have this condition is to take the following self-test (“wet footprint test”):

  • Wet your feet.
  • Stand on a surface like concrete where your footprints will be clearly visible.
  • If you see a complete imprint of the bottom of your feet, then you likely have fallen arches.


What Are Flat Feet?

The technical definition for “flat feet” (pes planus) is when the inside arches on the feet are flattened to the point where all parts of the foot touch the ground when standing.

If you are not experiencing any flat feet pain, treatment is usually not necessary.

However, the condition sometimes plays a role in problems with your ankles and knees, since feet that are flat to the ground can alter leg alignment and cause pain associated with movement.

It’s possible to have the condition in one foot only or both feet.

Symptoms associated with fallen arches may include:

  • Persistent foot pain not related to any other conditions
  • Arch or heal pain that worsens with strenuous activities
  • Visible swelling on the inside part of the ankle


Diagnosing Pes Planus

If the “wet foot test” fails to provide anything conclusive, a doctor can conduct a more detailed evaluation to determine if you have what’s sometimes termed “flatfeet syndrome”.

The process of diagnosising pes planus includes an x-ray of the foot, an MRI scan to exam the tendons of the foot, and/or a CT scan for a closer look at the bones of the foot.

Further efforts to accurately diagnose the condition may include:

  • Going over your health history
  • Checking for evidence of previously untreated or improperly healed injuries
  • Looking for unusual wear patterns on your shoes
  • Testing the strength of the muscles and tendons in each foot

A comparison between a normal foot and a flat foot.


Flat Feet Causes

Flat feet causes can range from an arch that fails to develop following birth to injuries affecting muscles, bones, and tendons within the foot.

One of the most common flatfeet causes is an abnormality that’s present at birth.

It can be difficult to determine if such an deformity or abnormality exists until further development.

Some children are born with what’s termed flexible flatfoot, a condition considered perfectly normal in babies and young children without a fully developed arch.

In some cases, arches may not fully form until the age of seven or eight.

Additional flat feet causes may include:

  • Torn or stretched tendons
  • Posterior tibial tendon inflammation*
  • Sudden injuries involving dislocated or broken bones
  • Rheumatoid arthritis and similar health conditions involving inflammation around joints
  • Nerve damage


*The posterior tibial tendon is the tendon that connects the lower leg and ankle to the middle arch in your foot.

Location of the posterior tibial tendon.


Contributing Conditions

Flat feet aches and pain can also be caused by contributing conditions – Diabetes, for instance, is often associated with high blood sugar levels that can cause problems with circulation that may contribute to pain associated with fallen or weakened arches.

Contributing conditions as such can also make symptoms worse, so managing such conditions may bring added relief.

Excess weight can also place added pressure on muscles and bones in the foot ankle.

Some women experience temporary issues with weakened arches during pregnancy.

Aging can aggravate the condition due to a reduction of bone density.


Non-symptomatic Flat Foot Pain

Most people dealing with flat feet have no symptoms associated with their fallen arches.

Part of the reason for this may be that most people who have arches that are below the normal level don’t have feet that are entirely flat, but rather mild to moderate degrees of weakened arches.

Regardless of the level of “flatness”, if no pain or discomfort is present, there no further treatment is necessary other than wearing comfortable shoes to minimize stress on the bones, joints, and muscles of the foot.

Multiple military studies found no difference in the performance of individuals with non-symptomatic fallen arches over those with normal arches.

In fact, one study found that military personnel with feet that were flat reported fewer injuries than service personnel with normal or higher arches.

Some studies suggest that the tibialis posterior muscle may be the source of weight-bearing issues for adults with feet that are considered flat.

Subsequent research suggests that wearing shoes with proper arch support can sometimes activate the tibialis posterior muscle to the point where proper weight support is provided.


Chart showing a random sample from a school that's reflective of what's seen among the general population.


Medical Solutions for Flat Feet Pain

In some cases, the only way of dealing with flat feet pain is to either take medication to control inflammation, which is usually the case if underlying conditions

like diabetes or arthritis are contributing to the problem, or undergo surgery to correct the problem.

Nerve function disorders, arthritis, and joint disease are some of the conditions that may result in flat feet aches and pains experienced in adulthood.


Rigid Flatfoot

Rigid flatfoot is one of the leading medical causes of flatfeet requiring treatment.

With rigid flatfoot, the sole of the foot is “rigidly flat” even when standing.

If there is no flexibility at all, it’s usually a sign that there is an issue with the bones of the affected foot.

About a quarter of the people with rigid flatfoot experience some degree of pain. Symptoms or signs of the condition include:

  • Feet with a convex rocker-bottom shape
  • Foot pain starting at the outside rear of the foot
  • Pain that’s aggravated by playing sports or walking on uneven ground

Rigid Flatfoot-Related Conditions

Feet that are flat can become increasingly painful with conditions like tarsal coalition, a condition where two or more bones of the mid-foot and hind-foot are improperly joined together,

and accessory navicular, a condition where an extra bone exists on the inner part of the foot.

Congenital vertical talus is a condition where there is no arch at all becomes the bones of one foot or both feet never formed properly.

All of these conditions will be present at birth.

Treatment usually involves corrective surgery taking place no later than the early teen years since bone structure has not yet become fully firm yet, and Abnormalities are confirmed by x-rays.


Rheumatoid Arthritis

Rheumatoid arthritis (RA) can play a role in foot pain and the development of fallen arches due to the inflammation of joints associated with the condition.

Over time, RA may destroy tendons in one or booth feet. If tendons are weakened or all together destroyed to the point of not being able to support any weight,

the resulting deformity can cause fallen arches. Early-onset osteoarthritis can produce similar results.

A flatfoot that’s combined with any of these conditions often results in extreme pain and a greatly reduced ability to walk without pain.

Treatment usually involves an ankle fusion to stabilize affected bones.

Possible complications of surgery include:

  • Loss of ankle movement
  • Infection at the surgery site
  • Persistent or recurring pain

Lateral Subtalar Dislocation

A lateral subtalar dislocation is when rigidity results from a sudden, traumatic, high-impact injury.

Pain is often instantly experienced, with the foot either visible swollen or deformed. Related symptoms can include bruising, extreme pain, or bleeding from an open wound.

Some symptoms of pain related to fallen or diminished arches aren’t that obviously linked to the foot. For instance,

flatfeet may result in you feeling tired or easily fatigued after walking due to an imbalance affecting the rest of your body.

Some other subtle signs of problem can include:

  • “Achy” or painful feet, especially around the heels
  • Swelling in the inside bottom of the feet
  • Increased difficulty standing or moving feet
  • Leg and back pain

Non-surgical Solutions

Surgery is often the last option to correct problems with arches.

Initial treatment recommendations focus on reducing inflammation and strengthening muscles and tendons supporting bones and joints within the feet.

Non-surgical solutions may include:

  • Application of ice coupled with rest to reduce swelling
  • Physical therapy with supervised stretching exercises
  • Shoe modifications such as insoles and other orthopedic devices
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroid injections for immediate relief of swelling

Note: The information presented here does not constitute professional medical advice.

Only your doctor can provide an accurate assessment of the source of any pain you may be experience due to weakened or fallen arches.


Managing Flatfoot-Related Pain

Even if you experience no problematic symptoms, there are steps that can be taken to effectively manage flatfoot pain when it does occur – or reduce the odds of experiencing any discomfort at all.

Another way of dealing with flat feet is finding a good pair of shoes with insoles that offer added support to minimize or eliminate pain.

Chart serving as a handy guide for choosing the right type of shoe.

Choosing the Right Shoes

First of all, multi-purpose shoes aren’t going to work well for you if you have some degree of weakened or fallen arches in your feet.

The process of choosing the right shoe starts with determining the purpose for your shoes.

Even when it comes to activities like walking and running, shoes for running are more flexible than those made for walking.

If your feet are flat, that means your feet roll inward since you have a low or non-existent arch.

You want shoes with some type of motion-control feature for optimal support.

Have a proper fitting to ensure that you’re getting shoes that are the right width and length for your feet.

It’s a myth that adult feet never change.

Sizes also tend to be slightly different by brand, so trying on a shoe before making a purchase is wise if you want to achieve an ideal fit.

Some other shoe-fit tips for your consideration include:

  • Do fittings with your socks or orthotics you normally wear to ensure a proper fit
  • Having to “break shoes in” is a myth, you should have a good fit right away
  • Leave about three-eighths to 3/8 to 1/2 inch of space between the front of your big toe and your desired shoe
  • Shoes with extra cushioning can be good if you have heel pain related to your arch problem, but not so good if you need more traction

Reduce flatfeet pain by taking the time properly measure your foot, a process illustrated in this diagram.


Choosing the Right Insoles

The purpose of insoles is to offer assistance controlling how your foot functions while standing or moving.

Insoles also provide extra protection to your feet and, if you have a problem with your arches, added comfort and stability.

Insoles are designed to contour to the shape of your foot.

The most important consideration with the selection of insoles is the arch of your foot.

Flat-to-medium arches benefit from more rigid inserts that help better control motion, a goal that’s usually achieved with a three-quarter length insole.

Full-length insoles offer additional padding in the forefoot that can also help compensate for arch issues.

Diagram illustrating the benefits offered by insoles.


The first step in the effort to manage or reduce flat feet pain is to determine the source of the pain or discomfort.

Your primary care physician should be able to recommend a podiatrist who can perform a through evaluation to determine if any medical remedies are necessary.

The good news is that most flat feet aches and pains can be corrected with the right shoes and comfortable insoles that provide added cushioning while standing, walking, or running.


A final note…

Hopefully we’ve successfully answered some questions you had about flat feet and fallen arches.

If you have any more questions, or any additional information, please submit it in the comment section below,

we’ll do our best to answer them as quickly as possible.


TheShoesForMe Team.

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